OBJECTIVE:Autonomous Emergency Braking (AEB) fitted to vehicles has proven road safety benefits in terms of preventing collisions with other vehicles. AEB with pedestrian detection (PAEB) extends this capability to protect vulnerable road users: the current paper evaluates these safety benefits in comparison with AEB without pedestrian detection and vehicles without any AEB. METHODS:We analyzed data from Australian and New Zealand crashes involving injury over the period 2016-2023. The target crash types for PAEB analyzed either involved a vulnerable road user or the vehicle was rear-ended by another vehicle. Vehicles listed in Redbook (which provides vehicle specification information to assist Australian vehicle purchasers) with the feature "Control - Pedestrian Avoidance with Braking" were classed as having PAEB; for other vehicles, "Collision Mitigation - Forward (High speed)" and "Collision Mitigation - Forward (Low speed)" identified other forms of AEB. Using an induced exposure approach, crash rates associated with the safety technology fitted were estimated. RESULTS:Controlling for jurisdiction, speed limit area, vehicle market group, driver age group and sex, weather, day/night and year of crash, there was a 17% reduction (95% CI 5% to 27%) in the rate of pedestrian or cyclist collisions associated with vehicles equipped with PAEB relative to vehicles without any AEB system; for vehicles equipped with AEB without pedestrian detection, there was no reduction in the rate of pedestrian or cyclist collisions. For collisions with motorcycles, the associated benefits were smaller: compared to vehicles with no AEB system, there was a statistically significant 11% reduction associated with PAEB (95% CI 0% to 21%) and a non-significant 8% reduction (95% CI an increase of 4% to a decrease of 19%) associated with other AEB system fitment. There were insufficient cyclists in the data to estimate benefits specifically for cyclists but there was no evidence that the associated benefit was any less than for pedestrians. The safety benefits for vulnerable road users associated with AEB with pedestrian detection were estimated to be higher at nighttime, contrary to some findings in other studies. CONCLUSIONS:The safety benefits associated with PAEB for vulnerable road users are significantly greater than AEB without pedestrian detection, and this analysis of real-world crash outcomes shows these benefits extend to the protection of motorcyclists.

OBJECTIVE:Blind spot monitoring systems help drivers avoid collisions with another vehicle when changing lanes. The systems provide visual and/or haptic warnings; active systems additionally avoid collision by applying brakes or steering the vehicle. This study aimed to estimate real-world effectiveness of these technologies as installed in the Australasian light vehicle fleet in Australasian road and driving conditions. METHODS:Police-recorded crash data were studied for the years 2019-2023 from the Australian states Victoria, Queensland, South Australia, New South Wales and Western Australia and also New Zealand. Using quasi-induced exposure analysis, rates of lane change crash involvements were studied for vehicles manufactured from 2018, classified by whether they were fitted with blind spot monitoring systems or not. RESULTS:We found a statistically significant 15% reduction (95% CI 26%-3%) in lane change crashes for vehicles equipped with a blind spot monitoring system. There was indicative evidence that the system was more effective for male than female drivers. For crashes involving injury, the associated reduction was estimated to be larger: a 24% reduction (95% CI 38%-6%). Active systems were rare in our data, but the analysis suggested they may be even more effective than the warning systems. CONCLUSIONS:Despite the relatively low prevalence of lane change crashes generally, the estimated 15% reduction is significant. In the Australasian crash data analyzed, older drivers had an elevated rate of lane change crashes and may consequently gain greater benefit from blind spot monitoring systems.

Introduction: Supervised driving during the learner phase of Graduated Driver Licensing (GDL) systems is designed to reduce novice driver crash risk by enabling skill development under low-risk conditions. This systematic review evaluated the effectiveness of mandated supervised driving practice requirements in improving road safety outcomes for newly independent drivers. Methods: A systematic search of public health-, psychology-, and transport-databases was conducted in July 2024. This systematic review was registered with PROSPERO (see CRD562807). Inclusion criteria required studies to quantify the effects of mandated supervised practice requirements on objective or self-reported safety outcomes post-licensure. Eighteen peer-reviewed studies published between 2003 and 2024 met eligibility criteria. Study quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools, and findings were synthesised narratively. Results: Evidence consistently supported longer learner permit-holding periods and structured driver training programs as protective factors for novice drivers, with reductions observed in crash involvement and traffic offences during early independent driving. Greater supervised practice experience was also associated with safer outcomes, although evidence isolating specific hour or distance thresholds was mixed. Very limited evidence exists regarding mandated exposure to varied driving conditions. Practical Application: The greatest safety benefits arise from providing learners with sufficient time and support to gain experience under supervision, coupled with structured training that develops hazard perception and decision-making skills. Conclusions: Supervised practice remains a critical element of GDL systems, particularly when combined with minimum permit durations and high-quality training. Further research isolating individual supervised practice components is required to determine the most effective and equitable requirements for improving novice driver safety.

Motor vehicle crashes account for the largest proportion of workplace fatalities among paramedics in developed countries. Systems thinking is one approach that is popular when seeking to understand and manage complex road safety issues; however, it has not been applied to ambulance crashes. A systematic literature review was conducted to examine factors associated with motor vehicle crashes involving ambulances, and the extent to which systems thinking has been applied in this area. Crash factors were categorised using the Accident Mapping technique (AcciMap) (based on six hierarchical levels ranging from government to the road environment) and then synthesised according to whether they were crash/injury crash risk factors or characteristics. Of the 24 included studies, most only reported factors associated with the driver and their immediate environment (n = 23). The most commonly identified factors were intersection location, emergency use of the ambulance (lights and sirens operational) and non-use of restraints (all associated with increased risk of crash or injury crash). Two-thirds of studies were at risk of bias. Given the prominence of lower-level factors associated with road users, vehicles, and the road environment, it is concluded that systems thinking approaches would be beneficial to understand ambulance crashes, particularly for higher level system factors. Further research is recommended to i) examine the potential contribution of factors and their interactions that go beyond the driver and their immediate environment and ii) validate the current findings based on the low number of studies and their lack of methodological rigour in examining driver, vehicle and environmental factors. The development of a crash data collection and reporting system in line with system thinking principles is recommended as a first step to support the identification and systemic analysis of contributory factors across the entire sociotechnical system.

Introduction: Road traffic crashes globally cause 1.3 million deaths yearly and the rate of nonfatal crashes is increasing. Nonfatal injuries impact long-term quality of life, which is often overlooked in evaluations. The preferred method for using health-related quality of life and disability for evaluating road safety interventions have not been established. Method: A scoping review of peer-reviewed and grey literature was undertaken to understand health-related quality of life and disability measures currently used to evaluate road safety interventions. We included English language studies that used any health-related quality of life or disability measure to evaluate any real-world intervention aimed at reducing the number or severity of road traffic crashes. Results: Nine different health-related quality of life measures were used in the 18 included studies. The most commonly used measure was a quality-adjusted life year, which was used by seven studies, followed by the Glasgow Outcome Scale used by five studies. Two studies used two different health-related quality of life or disability measures. Five studies used primary data (collected directly for the purpose of the study) and 13 studies used existing data sources not explicitly collected for the reported evaluation. Of these 13 studies, 5 used an injury registry as the data source. Six different methods of deriving utility weights for calculating quality-adjusted life years were used. Conclusions: This review found that evaluations of road safety interventions using health-related quality of life or disability measures were rare. There was a lack of consistency in the measures used which prevented comparisons across evaluations. Further, inconsistent methods were used to derive utility weights for quality-adjusted life years. Practical Applications: Future evaluations of roads safety interventions need to consider longer-term outcomes. Consistent methods for measuring health-related quality of life and disability burden are needed, as are empirically derived utility weights for quality-adjusted life years.

OBJECTIVES:Publicizing safety ratings of vehicles can motivate manufacturers to prioritize safety and help consumers choose safer vehicles, leading to safer fleets. The benefits of primary safety technologies that prevent crash occurrence are not currently incorporated in current ratings in a way that values their safety benefits consistently. We aimed to propose a method for assigning weights for each safety technology to account for established safety benefits using published effectiveness and prevalence from real-life data. METHODS:To illustrate this method, we present a worked example calculated using crash and injury data from Australia and New Zealand. The method proposed attenuates the weights for given safety technologies where two or more safety technologies fitted to the same vehicle are effective for the same types of crashes. RESULTS:In the worked example using Australasian data, large SUVs were estimated to have the largest safety increment from the fitment of all the technologies considered compared to vehicles without these primary safety technologies, with an almost 17% reduction in crash occurrence. Cars with all the technologies fitted had estimated average crash reduction of between 11% and 12%. CONCLUSIONS:Different market groups have different crash patterns, so the safety attributable to safety technology fitment differs at the market group level. This study presents an approach for providing a summary measure of crash avoidance according to the fitment of safety technologies. If this measure is combined with an estimate of secondary safety (whether derived from existing crash and injury data or from new car crash assessment programs), the combined estimate then represents the important elements of safety provided by the vehicle. The methods presented here form a rational basis for assigning safety ratings to represent the benefits of swiftly developing safety technologies.

BackgroundGlobally, road traffic crashes are the leading cause of death for young adults. The P Drivers Project was a trial of a behavioural change program developed for, and targeted at, young Australian drivers in their initial months of solo driving when crash risk is at its highest.MethodsIn a parallel group randomised controlled trial, drivers (N = 35,109) were recruited within 100 days of obtaining their probationary licence (allowing them to drive unaccompanied) and randomised to an intervention or control group. The intervention was a 3 to 6-week multi-stage driving behaviour change program (P Drivers Program). Surveys were administered at three time points (pre-Program, approximately one month post-Program and at 12 months after). The outcome evaluation employed an on-treatment analysis comprising the 2,419 intervention and 2,810 control participants who completed all required activities, comparing self-reported crashes and police-reported casualty crashes (primary outcome), infringements, self-reported attitudes and behaviours (secondary outcomes) between groups.ResultsThe P Drivers Program improved awareness of crash risk factors and intentions to drive more safely, relative to the controls; effects were maintained after 12-months. However, the Program did not reduce self-reported crashes or police-reported casualty crashes. In addition, self-reported violations, errors and risky driving behaviours increased in the intervention group compared to the control group as did recorded traffic infringements. This suggests that despite the Program increasing awareness of risky behaviour in novice drivers, behaviour did not improve. This reinforces the need to collect objective measures to accompany self-reported behaviour and intentions.ConclusionsThe P Drivers Program was successful in improving attitudes toward driving safety but the negative impact on behaviour, lack of effect on crashes, and the large loss to follow-up fail to support the use of a post-licensing behaviour change program to improve novice driver behaviour and reduce crashes.Trial registration: Australian New Zealand Clinical Trials Registry: 363,293 (ANZCTR, 2012).

While the relationship between vehicle speed and crash risk and severity are well understood, precise quantifications of the attribution of speeding to casualty crashes remains more elusive, due in part to the lack of reliable network-wide speed survey data. A relatively new source of network-wide speed data is Global Positioning System (GPS) probe data. This paper explores the feasibility of using this data, along with existing crash risk estimates, to determine the proportion of casualty crashes attributable to travelling at various speeds above the posted limit on Queensland roads. Findings were generally consistent with other data sources, highlighting the danger associated with high-level speeding (more than 20 km/h over the speed limit), estimating that up to 32.5% of all casualty crashes were attributable to this behaviour. Analyses also showed the risks associated with low-level speeding (1-10km/h over the limit), with up to 19.2% of all casualty crashes estimated to be attributable to such behaviour. The implications of these findings on road safety are discussed. Notwithstanding the limitations of GPS speed probe data, the findings suggest that it represents a promising source of network-wide speed data for estimating the attribution of speeding in casualty crashes. Efforts should be made to improve the reliability of this data by increasing the representativeness of vehicles contributing to the data.

BACKGROUND:Elite junior Australian football players experience high training loads across levels of competition and training. This, in conjunction with impaired wellness, can predispose athletes to injury.HYPOTHESIS:Elite junior Australian football players exposed to high loads with poor wellness are more likely to be at risk of injury than those with improved wellness.STUDY DESIGN:Longitudinal prospective cohort study.LEVEL OF EVIDENCE:Level 3.METHODS:Data were collected and analyzed from 280 players across the 2014 season. Internal load was measured via session rating of perceived exertion. Player wellness was reported according to ratings of sleep quality, fatigue, soreness, stress, and mood. Week- and month-based training load measures were calculated, representing a combination of absolute and relative load variables. Principal component analysis factor loadings, based on 17 load and wellness variables, were used to calculate summed variable covariates. Injury was defined as "any injury leading to a missed training session or competitive match." Associations between covariates and injury risk (yes/no) were determined via logistic generalized estimating equations.RESULTS:A significant interaction term between load and wellness on injury was found [odds ratio (OR) 0.76; 95% CI 0.62-0.92; P < 0.01), indicating that wellness acts as a "dimmer switch" of load on injury. Further, there was evidence of moderated mediation (OR 0.71; 95% CI 0.57-0.87; P < 0.01). When wellness was low, injury risk started to increase substantially at a 1-week load of 3250 au.CONCLUSIONS:Subjective measures of training load are associated with injury risk through a nonlinear relationship. This relationship is further influenced by player wellness, which can amplify the risk of injury. There is evidence that higher stress is linked with injury and that soreness and sleep mediate any stress-injury relationship.CLINICAL RELEVANCE:Coaching efforts to manage training load and player adaptive responses, including wellness, may reduce the risk of injury, with stress, soreness, and sleep particularly relevant at this level.

Objective: The current study aimed to quantify the real-world, everyday travel behaviours of child vehicle occupants and associations with child restraint systems (CRS)/booster seat (BS) head positions that are suboptimal in terms of crash injury risk.Methods: The data from a naturalistic driving study (NDS) provided 414 trips for analysis.Child occupant behaviour, head position within their forward-facing CRS (FFCRS) or BS and other relevant information was coded for nine discrete 5 s intervals or 'epochs' (5%, 17%, 25%, 30%, 50%, 53%, 75%, 89% & 95% of trip duration).A total of 2158 epochs were analysed.The relative contributions of factors of interest to suboptimal head position were explored through a generalised estimating equation (GEE), which accommodated correlation between measurement in each epoch for an individual child.Results: The GEE revealed that, when compared to child occupants travelling in a FFCRS, child occupants travelling in a BS were twice as likely to have a suboptimal head position.Child occupants were also nearly one and a half times more likely to have a suboptimal head position if they were in the older age range for the restraint type that they were using (FFCRS or BS), if they had incorrect shoulder belt/harness use, or if they were interacting with other vehicle occupants.In addition, when compared to engagement in conversation, children's engagement in a lap-based activity (including use of electronic devices, toys and reading) increased the odds of suboptimal head position by nearly two and half times,.Conclusions: This study identified key factors associated with child occupants' head positions when travelling in a CRS.These findings suggest that various head positions are adopted during everyday travel.Future restraint and vehicle designs that improve the ability of child occupant protection systems (CRS and vehicle-based devices) to safely accommodate a wide range of suboptimal head positions that were commonly observed during everyday travel are encouraged.

Introduction: Road crashes present a serious public health issue. Many people are seriously or fatally injured every year in avoidable crashes. While these crashes can have multiple contributing factors, including road design and condition, vehicle design and condition, the environment and human error, the performance of illegal driving behavior, including speeding, may also play a role. The current study aimed to examine the mediating influence that four potential deterrents (perceptions towards enforcement, crash risk, social norms and disapproval, and negative personal/emotional affect) have between the Big Five personality traits (conscientiousness; extraversion; agreeableness; neuroticism; openness) and expectations to speed. Methods: A total of 5,108 drivers in Victoria, Australia completed an online survey in 2019. A mediated regression analysis was used to examine pathways in a conceptual model developed for the study. Results: The results showed that perceptions towards the four potential deter-rents examined did mediate the relationship (either completely or partially) between personality and expectations to speed. Conclusions: The results of this study suggest that if interventions to deter illegal driving behavior are to be successful, one factor that could be taken into account is the personality traits of drivers who may be at greatest risk of the performance of illegal driving behaviors.(c) 2023 The Author(s). Published by the National Safety Council and Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Introduction: Many studies have found that daytime running lights (DRLS) are effective in reducing daytime multi-vehicle crashes. From an Australian perspective, while studies exist using data from other jurisdictions, there has been uncertainty about how effective DRLs would be under Australian environmental conditions, which can differ from other parts of the world. In addition, in recent years DRLs have become a standard feature of many new vehicles. The objective of this work was to utilize Australian crash data to estimate the impact of DRLs on casualty crash risk reflecting the Australian crash population and local conditions. It also aimed to broadly examine the real-world crash-based effectiveness of DRLs currently present in the light vehicle fleet. Method: The study utilized police reported casualty crash data for crashes that occurred during 2010-2017. The analysis used induced exposure methods, which offers the potential to assess the relationship between crash risk and DRL fitment by intrinsically controlling for confounding factors. Results: It was found that DRL fitment can reduce the overall risk of being involved in a non-nighttime multi-vehicle crash where vehicle visibility may be a factor in crash causation by a statistically significant 8.8%. Estimated crash reductions were higher at dawn or dusk and in higher speed zones. Conclusion: Results provide clear evidence that mandating DRLs on all new vehicles would likely lead to reductions in the overall crash risk of the fleet through accelerating fitment through the fleet. Practical Application: DRL fitment can reduce the overall risk of being involved in a non-night-time multi-vehicle crash where vehicle visibility may be a factor in crash causation. Governments should consider a DRL mandate on all new vehicle models, including all variants to accelerate the process of fitment through the fleet. This would likely lead to reductions in the overall crash risk of the fleet.& COPY; 2023 National Safety Council and Elsevier Ltd. All rights reserved.

By being able to communicate the speed limit to drivers using speed sign recognition cameras, Intelligent Speed Assist (ISA) is expected to bring significant road safety gains through increased speed compliance. In the absence of complete digital speed maps and due to limited cellular connectivity throughout Australia, this study estimated the forgone savings of ISA in the event that speed signs are solely relied upon for optimal advisory ISA function. First, speed-related fatalities and serious injuries (FSI) in the Australian states of Victoria, South Australia, and Queensland (2013–2018) were identified, and published effectiveness estimates of ISA were applied to determine the potential benefits of ISA. Subsequently, taking into account speed sign presence across the three states, the forgone savings of ISA were estimated as FSI that would not be prevented due to absent speed signage. Annually, 27–35% of speed-related FSI in each state are unlikely to be prevented by ISA because speed sign infrastructure is absent, equating to economic losses of between AUD 62 and 153 million. Despite a number of assumptions being made regarding ISA fitment and driver acceptance of the technology, conservative estimates suggest that the benefits of speed signs placed consistently across road classes and remoteness levels would far outweigh the costs expected from the absence of speed signs. The development and utilisation of a methodology for estimating the foregone benefits of ISA due to suboptimal road infrastructure constitutes a novel contribution to research. This work provides a means of identifying where infrastructure investments should be targeted to capitalise on benefits offered by advanced driver assist technologies.

Advanced driver assistance systems (ADAS) provide warnings to drivers and, if applicable, intervene to mitigate a collision if one is imminent. Autonomous emergency brakes (AEB) and lane keep assistance (LKA) systems are mandated in several new vehicles, given their predicted injury and fatality reduction benefits. These predicted benefits are based on the assumption that roads are always entirely supportive of ADAS technologies. Little research, however, has been conducted regarding the preparedness of the road network to support these technologies in Australia, given its vastly expansive terrain and varying road quality. The objective of this study was to estimate what proportion of crashes that are sensitive to AEB and LKA, would not be mitigated due to unsupportive road infrastructure, and therefore, the lost benefits of the technologies due to inadequate road infrastructure. To do this, previously identified technology effectiveness estimates and a published methodology for identifying ADAS-supportive infrastructure availability was applied to an estimated AEB and LKA-sensitive crash subset (using crash data from Victoria, South Australia and Queensland, 2013–2018 inclusive). Findings demonstrate that while the road networks across the three states appeared largely supportive of AEB technology, the lack of delineation across arterial and sub-arterial (or equivalent) roads is likely to have serious implications on road safety, given 13–23% of all fatal and serious injury (FSI) crashes that occurred on these road classes were LKA-sensitive. Based on historical crash data, over 37 fatalities and 357 serious injuries may not be avoided annually across the three Australian states based on the lack of satisfactory road delineation on arterial and sub-arterial (or equivalent) roads alone. Further, almost 24% of fatalities in Victoria, 24% of fatalities in Queensland and 21% of fatalities in South Australia (that are AEB- or LKA-sensitive) are unlikely to be prevented, given existing road infrastructure. These figures are conservative estimates of the lost benefits of the technologies as they only consider fatal and serious injury crashes and do not include minor injury or property damage crashes, the benefits of pedestrian-sensitive AEB crashes in high-speed zones or AEB fitted to heavy vehicles. It is timely for road investments to be considered, prioritised and allocated, given the anticipated penetration of the new technologies into the fleet, to ensure that the road infrastructure is capable of supporting the upcoming fleet safety improvements.

Drug driving continues to be overrepresented in both fatal and serious injury crashes in Victoria. As an enforcement countermeasure, preliminary oral fluid tests to detect drug driving were introduced in Victoria, Australia in December 2004. Recent research has modelled the relationships between prevalences of THC and methamphetamine in fatally and seriously injured drivers and (a) the annual numbers of random and targeted drug tests during 2010-2016 and (b) the positive detection rates from these tests. The increase in roadside drug tests in Victoria from 42,000 in 2013 (1% of licensed drivers) to 100,000 per year (2.2% of drivers), particularly targeted tests, is estimated to have saved 33 fatal crashes (13.7% reduction) and at least 80 serious injury crashes (1.4% reduction) per year. Based on the findings from this research, further increases in targeted and random roadside drug tests are warranted, up to at least 390,100 total tests per year, which are estimated to save a further 46 fatal crashes and at least a further 134 serious injury crashes per year.

Background Hospital-admitted patients are at risk of certain outcomes during hospital stay. They include admission to intensive care units (ICUs), placement on the ventilator and complications. Comorbidities could increase these risks. The Charlson Comorbidity Index (CCI) and the Elixhauser Comorbidity Measure (ECM), originally derived for mortality outcomes among general medical populations, are widely used for these in-hospital complications among injury populations. This study derived indices to specifically capture the effect of comorbidity on in-hospital complications for injury patients. Methods Retrospective data on injury hospital-admissions from July 2012 to June 2014 (161,334 patients) for the state of Victoria, Australia was analysed. Results from multivariable regression analysis were used to derive the Australian Injury Comorbidity Indices (AICIs) for ICU hours, ventilator hours and hospital-acquired complications. The AICIs, CCI and ECM were validated on data from Victoria and two other Australian states. Results Five comorbidities were significantly associated with ICU hours, two with ventilator hours and fifteen with complications. Not all diseases listed in the CCI or ECM were found to be associated with these outcomes. The AICIs performed equally well in terms of predictive ability to the long-listed ECM and in most instances outperformed the CCI. Conclusions Associations between outcomes and comorbidities vary based on the type of outcome measure. Learning Outcomes New comorbidity indices developed in this study provide a relevant, parsimonious and up-to-date capture of associations between comorbidities and in-hospital complications among injury patients, and is better suited for use in this context compared to the CCI and ECM.

Many jurisdictions globally have adopted a zero road trauma target by 2050 and an interim target of a 50% reduction by 2030. The objective of this study was to investigate what the road system will need to look like in order to achieve these respective targets. Utilising human tolerance to injury as the key design factor, this study defined the combination of vehicle, infrastructure, and travel speed requirements to manage crash energy in order to: (1) prevent all fatalities and serious injuries by 2050 in an Ultimate Safe System scenario; and (2) significantly reduce fatalities and severe injuries by 2030 in an Interim Safe System scenario. Victoria, Australia and its Movement and Place (M&P) framework was employed as a case study. With the vehicle and infrastructure countermeasures currently available coupled with appropriate travel speeds it is possible to construct an Ultimate Safe System that can manage crash forces to achieve zero trauma and an Interim Safe System that can significantly reduce the most severe injuries in Victoria. This study has demonstrated a potential pathway from the current situation to 2030 and then 2050 that can achieve safety targets while meeting the core objectives of the transport system.

Some New Car Assessment Programs (NCAPs) include pedestrian safety ratings based on crash tests. We compared 2,682 real-world Australasian pedestrian injury outcomes with pedestrian safety ratings provided by the Australasian NCAP within the speed limit areas where the collisions occurred. We found that the risk of a pedestrian fatal or severe (involving hospital treatment) injury was considerably reduced for the safest rated vehicles studied, but only in speed limit areas of 40km/h or less. From the perspective of promoting a safer system for pedestrians, these results imply that both lowered speed limits and a safer vehicle fleet are required.

Advanced driver assist systems are being promoted with the expectation that enhanced driver support will mitigate road trauma. While these technologies are optimised for certain road and traffic conditions, not all roads across Australasia are equipped with ADAS-supportive infrastructure. This study developed a desk-top methodology for using road classes (disaggregated by remoteness levels) to estimate the presence of quality roads, road delineation and speed signage in Victoria, Australia. Aerial imagery and mapping data were used to assess a number of random locations based on a developed protocol. The methodology demonstrated that in Victoria, major and arterial roads across all remoteness levels had high-quality sealed surfaces but 42% of all remote roads were unsealed. Delineation (crucial for lane support systems) were absent across 73% of sub-arterial roads independent of remoteness, and absent across 96% of sub-arterial roads in regional and remote areas. Speed sign availability across remote and regional areas was sparse, with only 65% of all roads assessed having signage. Results are reflective of Victoria’s road funding model and consistent with on-road audits conducted by other researchers. This methodology enables the proportion ADAS-ready roads to be estimated so the benefits of ADAS technologies can be quantified and investments into ADAS-supportive infrastructure be readily allocated.

Background Existing comorbidity measures predict mortality among general patient populations. Due to the lack of outcome specific and patient-group specific measures, the existing indices are also applied to non-mortality outcomes in injury epidemiology. This study derived indices to capture the association between comorbidity, and burden and readmission outcomes for injury populations. Methods Injury-related hospital admissions data from July 2012 to June 2014 (161,334 patients) for the state of Victoria, Australia were analyzed. Various multivariable regression models were run and results used to derive both binary and weighted indices that quantify the association between comorbidities and length of stay (LOS), hospital costs and readmissions. The new and existing indices were validated internally among patient subgroups, and externally using data from the states of New South Wales and Western Australia. Results Twenty-four comorbidities were significantly associated with overnight stay, twenty-seven with LOS, twenty-eight with costs, ten with all-cause and eleven with non-planned 30-day readmissions. The number of and types of comorbidities, and their relative impact were different to the associations established with the existing Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Measure (ECM). The new indices performed equally well to the long-listed ECM and in certain instances outperformed the CCI. Conclusions The more parsimonious, up to date, outcome and patient-specific indices presented in this study are better suited for use in present injury epidemiology. Their use can be trialed by hospital administrations in resource allocation models and patient classification models in clinical settings.